Paediatric medicine, ophthalmology, internal medicine, anaesthesiology, and intensive medicine. Different areas of medicine, which since September or October of this year have at least something in common, namely that the six clinics concerned received new heads. Everyone agrees that connection between a clinical and academic medicine is for top institutions a necessity. What they plan to develop and what they would do if they did not do medicine ... that and more is what we asked them shortly before the new heads of clinics assumed their posts.

We asked all new heads of clinics the following questions:

1. Where do you see the strong points of an institution which links clinical and academic medicine?

2. What do you want to contribute to your area of specialty and to the First Faculty of Medicine of the Charles University?

3. What is your scientific focus?

4. What would you do if you did not do medicine?

Photo: Markéta Sýkorová

Docent Jan Bláha, head of Department of Anaesthesiology and Intensive Care of the First Faculty of Medicine Charles University in Prague and General University Hospital in Prague (KARIM)

1. In my area, it is rather difficult to distinguish clearly between clinical and academic medicine. Anaesthesiology and especially intensive care are two mainly practical areas of medicine which must, however, continuously keep up not only with progress in medicine but also with ‘new’ patients. Thanks to new methods and especially technologies, we discover ever more progressed stages of critical states which we did not use to encounter before. Our area of medicine keeps developing and changing so fast that every hospital, clinic, or department where it is practiced must be at least somewhat academic just in order to function and keep pace with others. But still, there is one thing that distinguishes us from all other institutions – it is the prestige of the First Faculty of Medicine and the General University Hospital.

2. Support of simulation medicine. At the clinic, we have been trying to develop this training method for several years, and hopefully with some success, as evidenced for instance by our course Emergency Medicine in the Street or experiential half-day first aid course for freshmen in Dobronice. But the potential of simulation medicine in our area of medicine is much larger, and not only in undergraduate but above all in postgraduate medical education. Although there are at the faculty several successful teams which focus on simulation medicine, especially the Centre of Medical Simulations (SIM) of the Institute of Physiology, the faculty as a whole owes itself much more, both in undergraduate and especially postgraduate training. In advanced medical world, the education of new specialists and their integration into top teams is routinely based on not only theoretical knowledge and practical training but also, quite crucially, on simulation medicine. There are a number of top teams at the First Faculty of Medicine and the General University Hospital but no corresponding simulation centre …

3. Obstetric anaesthesia. It is quite surprising how many questions in this area are still unanswered, although for instance caesarean section is these days one of the most common surgical procedures globally. And it does not need to be issues on a subcellular level: we deal with basic questions such as the depth and influence of anaesthesia, epidural fever, or life-threatening bleeding.

4. I would probably do ‘outdoor training’ and personality development of individuals as well as work teams. I was engaged in experiential learning even at the beginning of my career for a number of years: professionally as instructor of the international organisation Outward Bound and as a volunteer at the Lipnice Summer School. I would say that from the perspective of my new positions, these experiences are crucial for me.

Prof. Michal Kršek, head of the 3^rd Medical Department of the First Faculty of Medicine of Charles University and the General University Hospital

1. I am convinced that the basic attribute of all departments in a university hospital should be a connection between clinical and academic medicine. It facilitates improvement of both of these elements. High quality of patient care contributes to the clinic’s good reputation and attracts interesting and complicated cases. Such patients are then a valuable source material for scientific work and clinical studies. Scientific studies in turn improve awareness of a clinic, attract further patients, and possibly also further clinical studies, possibilities of international collaboration, etc. Interesting patients are also important for teaching, which is an integral part of every department belonging to a university hospital. It all forms a mutually connected and mutually dependent system of activities, which ultimately result in a higher quality of treatment and preventive care, scientific work, and teaching at the place in question.

2. The 3^rd Medical Department is one of two clinics of internal medicine in the General University Hospital which are multidisciplinary, and I want to keep it that way. I believe it is important for the clinic, for the hospital, the faculty, and for internal medicine as such. It is estimated that within the next twenty years, requirements of hospital beds for general internal medicine will double. Given the current tendency of internal medicine towards fragmentation in more specialised fields, interest in general internal medicine is decreasing and so does the number of its hospital beds. I find that worrying and even more troublesome is the decrease in numbers of broadly educated internists who can take care of patients suffering from a number of diseases – and their numbers are on the rise. This trend should be stopped and reversed, otherwise our hospitals and our healthcare will be in serious trouble. My intention is therefore to support the development of general internal medicine and to encourage young doctors to choose internal medicine as their speciality. I also want to promote this trend on the level of the faculty and the hospital, although demanding intellectual work is not at the moment adequately remunerated. But I think this has to change. Really advanced countries, such as Switzerland, already understand that this is necessary.

The 3^rd Medical Department is the top place for endocrinology in our republic and it is very well respected even abroad. This is something I want to work on further and focus on increasing the clinic’s importance domestically and its involvement in projects and collaboration with centres abroad. Centralisation of superspecialised care is a trend that improves not only the quality of care but also of education and science, while lowering the costs. Naturally, we also need to increase our scientific production and work on its financial backing from science grants but also other, including commercial, sources.

3. In science, I focus on endocrinology, especially neuroendocrinology, diseases of the pituitary gland and adrenal glands, and the regulation axis hypothalamus–pituitary gland–adrenal cortex, and physiology of the IGF-I/STH system.

4. That is quite a difficult question. I have always tended to internal medicine, especially general internal medicine. But I believe that in every medical field, one can find one’s own place and particular specialisation to work on. So had the fate placed me in some non-internal medical field, I think I would have been able to find satisfaction there as well.

Doc. Martin Magner, head of the Department of Paediatrics of the First faculty of Medicine of the Charles University and Thomayer Hospital

1. I do not see much difference between clinical and academic medicine. Training of undergraduate students or recently graduated younger colleagues is a natural part of duties of all experienced physicians in all departments and clinics. Nowadays, any active physician has a chance of diagnosing even very rare diseases using the PubMed or UpToDate database even on the level of first contact with a patient. Outside academic departments, there may be less willingness to read at first sight incomprehensible English-written articles but there are many exceptions. The advantage of an academic department is in the people who have that courage. Physicians who notice the often slight deviations from the everyday ‘normal’ course of disease, people who have the courage to challenge long-establish dogmas.

2. The catchword of my approach, with which I went into the selection process, was ‘Modern paediatrics in a friendly environment’. I value especially highly people who are like that. Such people have great potential and can achieve much. I want to fight for good conditions in which they can develop, I want to motivate them and help them find joy in their work. I believe that that will in turn benefit not only the children we treat and their parents, but also our alma mater.

3. During my postgraduate studies, I started, under Professor Zeman’s supervision, to focus on disorders of mitochondrial metabolism in children. Then I moved a couple dozen nanometres further to lysosomes and lysosomal storage diseases. I am also trying to better understand the world of autism in children, but that keeps its secrets behind very high walls.

4. Paediatric medicine is wonderful, and I cannot imagine doing anything else. But then again, everything around is so interesting – history, mathematics, law, economy. To enter those areas and enjoy these worlds. I would like to have time to write books and compose music but given my workload, the time is not there. Perhaps when after some years I hand my position over to someone who would have more energy than I.

prof. MUDr. Radan Brůha, CSc., doc. MUDr. Jan Bláha, Ph.D., doc. MUDr. Martin Šín ,Ph.D., prof. MUDr. Jiří Chomiak, CSc., doc. MUDr. Martin Magner, Ph.D., a prof. MUDr. Michal Kršek, CSc.

Photo: Markéta Sýkorová

Docent Martin Šín, head of the Eye Clinic of the First Faculty of Medicine of the Charles University and Military University Hospital

1. From my perspective, such a link is necessary if a hospital department is to provide top care and move its area of specialisation further. It is a mutually enriching symbiosis. Theoretical fields which focus on science can in this respect help clinical medical specialties for which scientific research may be not a top priority due to economic and operational reasons. Representatives of clinical fields, on the other hand, can provide information on the current needs of clinical care and thereby supply the academic sphere with research topics. What is thus optimal is a well-balanced mix of the two.

2. In ophthalmology, I would like to continue in my research on venous blood supply to the retina and oxygen saturation. I hope to continue in this area where I had already published a number of works. I would like to integrate the clinic into an international network of centres which focus on this issue. Most of all, however, I would like the clinic to remain a valid and useful part of both institutions to which it belongs, that is, both the Military University Hospital for its clinical work and the First Faculty of Medicine of the Charles University for its academic work.

3. In both clinical work and research I focus on diseases of the retina. My particular area of interest is oxygen metabolism of the retina. Many diseases and disorders of the retina, such as diabetic retinopathy or retinal vein occlusion are caused by disorders of blood supply. These then lead to hypoxia and subsequent damage to the structures and function of the retina. For many years, we were able to measure changes to retinal oxygen saturation only by invasive methods. Now, however, we can do it by spectrophotometry, that is, without damaging the eye tissues. Different oxygen levels can tell us much about the prognosis, treatment response, or likely success of the treatment. It is a completely new approach, still so to speak ‘in its nappies’, but I think it has a great potential. It is also interesting to note that retina is the only visible part of the central nervous system so it is possible that these methods could be applied not only in ophthalmology but also in neurology.

4. That is an interesting question and I do not think I have ever paid it much thought. I must admit that given our family tradition – my father is also an ophthalmologist – I never considered another medical specialisation. I am absolutely happy with my choice. On the other hand, I believe that all areas of medicine have their beauty and one can find his or her own in each and every one. So, it does not actually matter where one decides to go after graduation. If I were to understand this question as aiming outside medicine, then I think I would like something in construction, for instance transport infrastructure.

Professor Radan Brůha, head of the 4^th Department of Internal Medicine of the First Faculty of Medicine of the Charles University and the General University Hospital

1. In a clinical department, one cannot separate these two aspects and to different degrees, they are an essential part of the work of most physicians. In contrast to clinical work, however, science can take different forms: it can mean something very different to a clinician and to a molecular biologist. In clinical medicine, research consists mostly in search for new connections and previously unknown information. It is something on top of daily specialised work, where well-tried and time-tested routines do not suffice. Nowadays, when daily medical practice involves ever more nonsensical and time-consuming administrative work, science can be an escape to a more meaningful activity. But that does not mean that science, or especially science, is not really hard work. Another part of academic life is work with students. That is often a source of inspiration and it often helps us see things in new and unexpected contexts.

2. Clinical medicine and scientific research are becoming ever more closely connected not only with each other but also with other medical fields. I cannot imagine further development without multidisciplinary cooperation. That is why one of my main goals is to involve the clinic more in interdisciplinary collaboration and make it more active in finding joint projects.

3. Scientific work is never the work of one individual. Our group focuses mainly on diseases of the liver. With a grain of salt, one could say that we focus on the most common and the least common ones. Among the most common ones are liver disorders linked to civilisation burden, that is, the fatty liver in obesity, which often leads to advanced disease of the liver and cirrhosis. Some of the rare ones are congenital metabolic liver disorders. At our clinic, we for instance follow one of the largest sets of patients with Wilson’s disease in the world, but we also do research on porphyria, and much else.

4. I do not think I would now want to do any other medical field. For one thing, I like my work, and secondly, I dedicated almost all of my professional life to acquiring necessary practice. In secondary school. I was deciding between medicine and some technical field: medicine won. But recently I am starting to ask myself one provocative question, namely whether I and my family won by this as well.

Prof. Jiří Chomiak, head of the Department of Orthopaedics of the First Faculty of Medicine of the Charles University and Na Bulovce University Hospital

1. I see the main advantages in four areas. First of all, this way we can share theoretical information as well as practical skills currently applied in clinical practice all over the world with both undergraduate students and postgraduate physicians. Secondly, it creates an opportunity of postgraduate education for clinicians in the area of experimental surgery – that is enabled by collaboration with theoretical institutes. The third advantage is in a chance of acquiring, after meeting the requisite criteria, further scientific and academic degrees and titles without the need to get teaching posts at other medical faculties. I experienced that when our department was not yet part of the First Faculty of Medicine. And fourthly, there are the opportunities created by faculty or university grant projects and plan of this department’s strategic development.

2. Our clinic is unique in focusing on all parts of orthopaedics and that is why I will try to keep on maintaining a high standard of care in all specialisations. I will also support efforts to acquire the status of centre of highly specialised care in traumatology of the musculoskeletal system and in haemophiliac care. With respect to teaching, I would like to improve the quality of education of students of both the Czech and the English programme and provide further individual education to those who are interested. In postgraduate education, I want to maintain our department’s position in the system of physicians’ education including training courses in sonography of children’s hips, treatment of clubfoot, and others. Among other things, I would like to send colleagues from the department abroad for further training courses and help international colleagues arrange training stays at our department.

In science and research, I will require that all physicians regularly publish. I will motivate them to start doctoral studies, acquire further academic titles and participate in research projects. In general, I want to build our research activities on firm foundations based on collaboration with the theoretical departments of the First Faculty of Medicine. In this way, I would like to show that orthopaedics is not based on a mere routine. New subjects worthy of scientific research are here and can shift this medical specialty further. I will also try to make sure that our department is an active member of both domestic and international scientific societies. I will make sure that the work of FIFA Medical Center of Excellence, the only centre in the Czech Republic accredited for care of footballers’ health, will continue. On top of that, we want to establish our department also as a centre of excellence in care for other sportsmen and sportswomen.

3. It is mainly the full range of paediatric orthopaedics with special focus on neuromuscular disorders. In that area, I still use knowledge acquired during my work at the Institute of Anatomy of the First Faculty of Medicine of the Charles University during my studies and then also my knowledge of neurophysiology and electromyography.

4. I would probably work at the Institute of Anatomy, where I worked during my studies and then another year after my military service in Professor Grim’s lab. Its gave me valuable foundation for further scientific work – applied research in orthopaedics.

jat

Paediatric medicine, ophthalmology, internal medicine, anaesthesiology, and intensive medicine. Different areas of medicine, which since September or October of this year have at least something in common, namely that the six clinics concerned received new heads. Everyone agrees that connection between a clinical and academic medicine is for top institutions a necessity. What they plan to develop and what they would do if they did not do medicine ... that and more is what we asked them shortly before the new heads of clinics assumed their posts.

We asked all new heads of clinics the following questions:

1. Where do you see the strong points of an institution which links clinical and academic medicine?

2. What do you want to contribute to your area of specialty and to the First Faculty of Medicine of the Charles University?

3. What is your scientific focus?

4. What would you do if you did not do medicine?

Photo: Markéta Sýkorová

Docent Jan Bláha, head of Department of Anaesthesiology and Intensive Care of the First Faculty of Medicine Charles University in Prague and General University Hospital in Prague (KARIM)

1. In my area, it is rather difficult to distinguish clearly between clinical and academic medicine. Anaesthesiology and especially intensive care are two mainly practical areas of medicine which must, however, continuously keep up not only with progress in medicine but also with ‘new’ patients. Thanks to new methods and especially technologies, we discover ever more progressed stages of critical states which we did not use to encounter before. Our area of medicine keeps developing and changing so fast that every hospital, clinic, or department where it is practiced must be at least somewhat academic just in order to function and keep pace with others. But still, there is one thing that distinguishes us from all other institutions – it is the prestige of the First Faculty of Medicine and the General University Hospital.

2. Support of simulation medicine. At the clinic, we have been trying to develop this training method for several years, and hopefully with some success, as evidenced for instance by our course Emergency Medicine in the Street or experiential half-day first aid course for freshmen in Dobronice. But the potential of simulation medicine in our area of medicine is much larger, and not only in undergraduate but above all in postgraduate medical education. Although there are at the faculty several successful teams which focus on simulation medicine, especially the Centre of Medical Simulations (SIM) of the Institute of Physiology, the faculty as a whole owes itself much more, both in undergraduate and especially postgraduate training. In advanced medical world, the education of new specialists and their integration into top teams is routinely based on not only theoretical knowledge and practical training but also, quite crucially, on simulation medicine. There are a number of top teams at the First Faculty of Medicine and the General University Hospital but no corresponding simulation centre …

3. Obstetric anaesthesia. It is quite surprising how many questions in this area are still unanswered, although for instance caesarean section is these days one of the most common surgical procedures globally. And it does not need to be issues on a subcellular level: we deal with basic questions such as the depth and influence of anaesthesia, epidural fever, or life-threatening bleeding.

4. I would probably do ‘outdoor training’ and personality development of individuals as well as work teams. I was engaged in experiential learning even at the beginning of my career for a number of years: professionally as instructor of the international organisation Outward Bound and as a volunteer at the Lipnice Summer School. I would say that from the perspective of my new positions, these experiences are crucial for me.

Prof. Michal Kršek, head of the 3^rd Medical Department of the First Faculty of Medicine of Charles University and the General University Hospital

1. I am convinced that the basic attribute of all departments in a university hospital should be a connection between clinical and academic medicine. It facilitates improvement of both of these elements. High quality of patient care contributes to the clinic’s good reputation and attracts interesting and complicated cases. Such patients are then a valuable source material for scientific work and clinical studies. Scientific studies in turn improve awareness of a clinic, attract further patients, and possibly also further clinical studies, possibilities of international collaboration, etc. Interesting patients are also important for teaching, which is an integral part of every department belonging to a university hospital. It all forms a mutually connected and mutually dependent system of activities, which ultimately result in a higher quality of treatment and preventive care, scientific work, and teaching at the place in question.

2. The 3^rd Medical Department is one of two clinics of internal medicine in the General University Hospital which are multidisciplinary, and I want to keep it that way. I believe it is important for the clinic, for the hospital, the faculty, and for internal medicine as such. It is estimated that within the next twenty years, requirements of hospital beds for general internal medicine will double. Given the current tendency of internal medicine towards fragmentation in more specialised fields, interest in general internal medicine is decreasing and so does the number of its hospital beds. I find that worrying and even more troublesome is the decrease in numbers of broadly educated internists who can take care of patients suffering from a number of diseases – and their numbers are on the rise. This trend should be stopped and reversed, otherwise our hospitals and our healthcare will be in serious trouble. My intention is therefore to support the development of general internal medicine and to encourage young doctors to choose internal medicine as their speciality. I also want to promote this trend on the level of the faculty and the hospital, although demanding intellectual work is not at the moment adequately remunerated. But I think this has to change. Really advanced countries, such as Switzerland, already understand that this is necessary.

The 3^rd Medical Department is the top place for endocrinology in our republic and it is very well respected even abroad. This is something I want to work on further and focus on increasing the clinic’s importance domestically and its involvement in projects and collaboration with centres abroad. Centralisation of superspecialised care is a trend that improves not only the quality of care but also of education and science, while lowering the costs. Naturally, we also need to increase our scientific production and work on its financial backing from science grants but also other, including commercial, sources.

3. In science, I focus on endocrinology, especially neuroendocrinology, diseases of the pituitary gland and adrenal glands, and the regulation axis hypothalamus–pituitary gland–adrenal cortex, and physiology of the IGF-I/STH system.

4. That is quite a difficult question. I have always tended to internal medicine, especially general internal medicine. But I believe that in every medical field, one can find one’s own place and particular specialisation to work on. So had the fate placed me in some non-internal medical field, I think I would have been able to find satisfaction there as well.

Doc. Martin Magner, head of the Department of Paediatrics of the First faculty of Medicine of the Charles University and Thomayer Hospital

1. I do not see much difference between clinical and academic medicine. Training of undergraduate students or recently graduated younger colleagues is a natural part of duties of all experienced physicians in all departments and clinics. Nowadays, any active physician has a chance of diagnosing even very rare diseases using the PubMed or UpToDate database even on the level of first contact with a patient. Outside academic departments, there may be less willingness to read at first sight incomprehensible English-written articles but there are many exceptions. The advantage of an academic department is in the people who have that courage. Physicians who notice the often slight deviations from the everyday ‘normal’ course of disease, people who have the courage to challenge long-establish dogmas.

2. The catchword of my approach, with which I went into the selection process, was ‘Modern paediatrics in a friendly environment’. I value especially highly people who are like that. Such people have great potential and can achieve much. I want to fight for good conditions in which they can develop, I want to motivate them and help them find joy in their work. I believe that that will in turn benefit not only the children we treat and their parents, but also our alma mater.

3. During my postgraduate studies, I started, under Professor Zeman’s supervision, to focus on disorders of mitochondrial metabolism in children. Then I moved a couple dozen nanometres further to lysosomes and lysosomal storage diseases. I am also trying to better understand the world of autism in children, but that keeps its secrets behind very high walls.

4. Paediatric medicine is wonderful, and I cannot imagine doing anything else. But then again, everything around is so interesting – history, mathematics, law, economy. To enter those areas and enjoy these worlds. I would like to have time to write books and compose music but given my workload, the time is not there. Perhaps when after some years I hand my position over to someone who would have more energy than I.

prof. MUDr. Radan Brůha, CSc., doc. MUDr. Jan Bláha, Ph.D., doc. MUDr. Martin Šín ,Ph.D., prof. MUDr. Jiří Chomiak, CSc., doc. MUDr. Martin Magner, Ph.D., a prof. MUDr. Michal Kršek, CSc.

Photo: Markéta Sýkorová

Docent Martin Šín, head of the Eye Clinic of the First Faculty of Medicine of the Charles University and Military University Hospital

1. From my perspective, such a link is necessary if a hospital department is to provide top care and move its area of specialisation further. It is a mutually enriching symbiosis. Theoretical fields which focus on science can in this respect help clinical medical specialties for which scientific research may be not a top priority due to economic and operational reasons. Representatives of clinical fields, on the other hand, can provide information on the current needs of clinical care and thereby supply the academic sphere with research topics. What is thus optimal is a well-balanced mix of the two.

2. In ophthalmology, I would like to continue in my research on venous blood supply to the retina and oxygen saturation. I hope to continue in this area where I had already published a number of works. I would like to integrate the clinic into an international network of centres which focus on this issue. Most of all, however, I would like the clinic to remain a valid and useful part of both institutions to which it belongs, that is, both the Military University Hospital for its clinical work and the First Faculty of Medicine of the Charles University for its academic work.

3. In both clinical work and research I focus on diseases of the retina. My particular area of interest is oxygen metabolism of the retina. Many diseases and disorders of the retina, such as diabetic retinopathy or retinal vein occlusion are caused by disorders of blood supply. These then lead to hypoxia and subsequent damage to the structures and function of the retina. For many years, we were able to measure changes to retinal oxygen saturation only by invasive methods. Now, however, we can do it by spectrophotometry, that is, without damaging the eye tissues. Different oxygen levels can tell us much about the prognosis, treatment response, or likely success of the treatment. It is a completely new approach, still so to speak ‘in its nappies’, but I think it has a great potential. It is also interesting to note that retina is the only visible part of the central nervous system so it is possible that these methods could be applied not only in ophthalmology but also in neurology.

4. That is an interesting question and I do not think I have ever paid it much thought. I must admit that given our family tradition – my father is also an ophthalmologist – I never considered another medical specialisation. I am absolutely happy with my choice. On the other hand, I believe that all areas of medicine have their beauty and one can find his or her own in each and every one. So, it does not actually matter where one decides to go after graduation. If I were to understand this question as aiming outside medicine, then I think I would like something in construction, for instance transport infrastructure.

Professor Radan Brůha, head of the 4^th Department of Internal Medicine of the First Faculty of Medicine of the Charles University and the General University Hospital

1. In a clinical department, one cannot separate these two aspects and to different degrees, they are an essential part of the work of most physicians. In contrast to clinical work, however, science can take different forms: it can mean something very different to a clinician and to a molecular biologist. In clinical medicine, research consists mostly in search for new connections and previously unknown information. It is something on top of daily specialised work, where well-tried and time-tested routines do not suffice. Nowadays, when daily medical practice involves ever more nonsensical and time-consuming administrative work, science can be an escape to a more meaningful activity. But that does not mean that science, or especially science, is not really hard work. Another part of academic life is work with students. That is often a source of inspiration and it often helps us see things in new and unexpected contexts.

2. Clinical medicine and scientific research are becoming ever more closely connected not only with each other but also with other medical fields. I cannot imagine further development without multidisciplinary cooperation. That is why one of my main goals is to involve the clinic more in interdisciplinary collaboration and make it more active in finding joint projects.

3. Scientific work is never the work of one individual. Our group focuses mainly on diseases of the liver. With a grain of salt, one could say that we focus on the most common and the least common ones. Among the most common ones are liver disorders linked to civilisation burden, that is, the fatty liver in obesity, which often leads to advanced disease of the liver and cirrhosis. Some of the rare ones are congenital metabolic liver disorders. At our clinic, we for instance follow one of the largest sets of patients with Wilson’s disease in the world, but we also do research on porphyria, and much else.

4. I do not think I would now want to do any other medical field. For one thing, I like my work, and secondly, I dedicated almost all of my professional life to acquiring necessary practice. In secondary school. I was deciding between medicine and some technical field: medicine won. But recently I am starting to ask myself one provocative question, namely whether I and my family won by this as well.

Prof. Jiří Chomiak, head of the Department of Orthopaedics of the First Faculty of Medicine of the Charles University and Na Bulovce University Hospital

1. I see the main advantages in four areas. First of all, this way we can share theoretical information as well as practical skills currently applied in clinical practice all over the world with both undergraduate students and postgraduate physicians. Secondly, it creates an opportunity of postgraduate education for clinicians in the area of experimental surgery – that is enabled by collaboration with theoretical institutes. The third advantage is in a chance of acquiring, after meeting the requisite criteria, further scientific and academic degrees and titles without the need to get teaching posts at other medical faculties. I experienced that when our department was not yet part of the First Faculty of Medicine. And fourthly, there are the opportunities created by faculty or university grant projects and plan of this department’s strategic development.

2. Our clinic is unique in focusing on all parts of orthopaedics and that is why I will try to keep on maintaining a high standard of care in all specialisations. I will also support efforts to acquire the status of centre of highly specialised care in traumatology of the musculoskeletal system and in haemophiliac care. With respect to teaching, I would like to improve the quality of education of students of both the Czech and the English programme and provide further individual education to those who are interested. In postgraduate education, I want to maintain our department’s position in the system of physicians’ education including training courses in sonography of children’s hips, treatment of clubfoot, and others. Among other things, I would like to send colleagues from the department abroad for further training courses and help international colleagues arrange training stays at our department.

In science and research, I will require that all physicians regularly publish. I will motivate them to start doctoral studies, acquire further academic titles and participate in research projects. In general, I want to build our research activities on firm foundations based on collaboration with the theoretical departments of the First Faculty of Medicine. In this way, I would like to show that orthopaedics is not based on a mere routine. New subjects worthy of scientific research are here and can shift this medical specialty further. I will also try to make sure that our department is an active member of both domestic and international scientific societies. I will make sure that the work of FIFA Medical Center of Excellence, the only centre in the Czech Republic accredited for care of footballers’ health, will continue. On top of that, we want to establish our department also as a centre of excellence in care for other sportsmen and sportswomen.

3. It is mainly the full range of paediatric orthopaedics with special focus on neuromuscular disorders. In that area, I still use knowledge acquired during my work at the Institute of Anatomy of the First Faculty of Medicine of the Charles University during my studies and then also my knowledge of neurophysiology and electromyography.

4. I would probably work at the Institute of Anatomy, where I worked during my studies and then another year after my military service in Professor Grim’s lab. Its gave me valuable foundation for further scientific work – applied research in orthopaedics.

jat

Paediatric medicine, ophthalmology, internal medicine, anaesthesiology, and intensive medicine. Different areas of medicine, which since September or October of this year have at least something in common, namely that the six clinics concerned received new heads. Everyone agrees that connection between a clinical and academic medicine is for top institutions a necessity. What they plan to develop and what they would do if they did not do medicine ... that and more is what we asked them shortly before the new heads of clinics assumed their posts.

We asked all new heads of clinics the following questions:

1. Where do you see the strong points of an institution which links clinical and academic medicine?

2. What do you want to contribute to your area of specialty and to the First Faculty of Medicine of the Charles University?

3. What is your scientific focus?

4. What would you do if you did not do medicine?

Photo: Markéta Sýkorová

Docent Jan Bláha, head of Department of Anaesthesiology and Intensive Care of the First Faculty of Medicine Charles University in Prague and General University Hospital in Prague (KARIM)

1. In my area, it is rather difficult to distinguish clearly between clinical and academic medicine. Anaesthesiology and especially intensive care are two mainly practical areas of medicine which must, however, continuously keep up not only with progress in medicine but also with ‘new’ patients. Thanks to new methods and especially technologies, we discover ever more progressed stages of critical states which we did not use to encounter before. Our area of medicine keeps developing and changing so fast that every hospital, clinic, or department where it is practiced must be at least somewhat academic just in order to function and keep pace with others. But still, there is one thing that distinguishes us from all other institutions – it is the prestige of the First Faculty of Medicine and the General University Hospital.

2. Support of simulation medicine. At the clinic, we have been trying to develop this training method for several years, and hopefully with some success, as evidenced for instance by our course Emergency Medicine in the Street or experiential half-day first aid course for freshmen in Dobronice. But the potential of simulation medicine in our area of medicine is much larger, and not only in undergraduate but above all in postgraduate medical education. Although there are at the faculty several successful teams which focus on simulation medicine, especially the Centre of Medical Simulations (SIM) of the Institute of Physiology, the faculty as a whole owes itself much more, both in undergraduate and especially postgraduate training. In advanced medical world, the education of new specialists and their integration into top teams is routinely based on not only theoretical knowledge and practical training but also, quite crucially, on simulation medicine. There are a number of top teams at the First Faculty of Medicine and the General University Hospital but no corresponding simulation centre …

3. Obstetric anaesthesia. It is quite surprising how many questions in this area are still unanswered, although for instance caesarean section is these days one of the most common surgical procedures globally. And it does not need to be issues on a subcellular level: we deal with basic questions such as the depth and influence of anaesthesia, epidural fever, or life-threatening bleeding.

4. I would probably do ‘outdoor training’ and personality development of individuals as well as work teams. I was engaged in experiential learning even at the beginning of my career for a number of years: professionally as instructor of the international organisation Outward Bound and as a volunteer at the Lipnice Summer School. I would say that from the perspective of my new positions, these experiences are crucial for me.

Prof. Michal Kršek, head of the 3^rd Medical Department of the First Faculty of Medicine of Charles University and the General University Hospital

1. I am convinced that the basic attribute of all departments in a university hospital should be a connection between clinical and academic medicine. It facilitates improvement of both of these elements. High quality of patient care contributes to the clinic’s good reputation and attracts interesting and complicated cases. Such patients are then a valuable source material for scientific work and clinical studies. Scientific studies in turn improve awareness of a clinic, attract further patients, and possibly also further clinical studies, possibilities of international collaboration, etc. Interesting patients are also important for teaching, which is an integral part of every department belonging to a university hospital. It all forms a mutually connected and mutually dependent system of activities, which ultimately result in a higher quality of treatment and preventive care, scientific work, and teaching at the place in question.

2. The 3^rd Medical Department is one of two clinics of internal medicine in the General University Hospital which are multidisciplinary, and I want to keep it that way. I believe it is important for the clinic, for the hospital, the faculty, and for internal medicine as such. It is estimated that within the next twenty years, requirements of hospital beds for general internal medicine will double. Given the current tendency of internal medicine towards fragmentation in more specialised fields, interest in general internal medicine is decreasing and so does the number of its hospital beds. I find that worrying and even more troublesome is the decrease in numbers of broadly educated internists who can take care of patients suffering from a number of diseases – and their numbers are on the rise. This trend should be stopped and reversed, otherwise our hospitals and our healthcare will be in serious trouble. My intention is therefore to support the development of general internal medicine and to encourage young doctors to choose internal medicine as their speciality. I also want to promote this trend on the level of the faculty and the hospital, although demanding intellectual work is not at the moment adequately remunerated. But I think this has to change. Really advanced countries, such as Switzerland, already understand that this is necessary.

The 3^rd Medical Department is the top place for endocrinology in our republic and it is very well respected even abroad. This is something I want to work on further and focus on increasing the clinic’s importance domestically and its involvement in projects and collaboration with centres abroad. Centralisation of superspecialised care is a trend that improves not only the quality of care but also of education and science, while lowering the costs. Naturally, we also need to increase our scientific production and work on its financial backing from science grants but also other, including commercial, sources.

3. In science, I focus on endocrinology, especially neuroendocrinology, diseases of the pituitary gland and adrenal glands, and the regulation axis hypothalamus–pituitary gland–adrenal cortex, and physiology of the IGF-I/STH system.

4. That is quite a difficult question. I have always tended to internal medicine, especially general internal medicine. But I believe that in every medical field, one can find one’s own place and particular specialisation to work on. So had the fate placed me in some non-internal medical field, I think I would have been able to find satisfaction there as well.

Doc. Martin Magner, head of the Department of Paediatrics of the First faculty of Medicine of the Charles University and Thomayer Hospital

1. I do not see much difference between clinical and academic medicine. Training of undergraduate students or recently graduated younger colleagues is a natural part of duties of all experienced physicians in all departments and clinics. Nowadays, any active physician has a chance of diagnosing even very rare diseases using the PubMed or UpToDate database even on the level of first contact with a patient. Outside academic departments, there may be less willingness to read at first sight incomprehensible English-written articles but there are many exceptions. The advantage of an academic department is in the people who have that courage. Physicians who notice the often slight deviations from the everyday ‘normal’ course of disease, people who have the courage to challenge long-establish dogmas.

2. The catchword of my approach, with which I went into the selection process, was ‘Modern paediatrics in a friendly environment’. I value especially highly people who are like that. Such people have great potential and can achieve much. I want to fight for good conditions in which they can develop, I want to motivate them and help them find joy in their work. I believe that that will in turn benefit not only the children we treat and their parents, but also our alma mater.

3. During my postgraduate studies, I started, under Professor Zeman’s supervision, to focus on disorders of mitochondrial metabolism in children. Then I moved a couple dozen nanometres further to lysosomes and lysosomal storage diseases. I am also trying to better understand the world of autism in children, but that keeps its secrets behind very high walls.

4. Paediatric medicine is wonderful, and I cannot imagine doing anything else. But then again, everything around is so interesting – history, mathematics, law, economy. To enter those areas and enjoy these worlds. I would like to have time to write books and compose music but given my workload, the time is not there. Perhaps when after some years I hand my position over to someone who would have more energy than I.

prof. MUDr. Radan Brůha, CSc., doc. MUDr. Jan Bláha, Ph.D., doc. MUDr. Martin Šín ,Ph.D., prof. MUDr. Jiří Chomiak, CSc., doc. MUDr. Martin Magner, Ph.D., a prof. MUDr. Michal Kršek, CSc.

Photo: Markéta Sýkorová

Docent Martin Šín, head of the Eye Clinic of the First Faculty of Medicine of the Charles University and Military University Hospital

1. From my perspective, such a link is necessary if a hospital department is to provide top care and move its area of specialisation further. It is a mutually enriching symbiosis. Theoretical fields which focus on science can in this respect help clinical medical specialties for which scientific research may be not a top priority due to economic and operational reasons. Representatives of clinical fields, on the other hand, can provide information on the current needs of clinical care and thereby supply the academic sphere with research topics. What is thus optimal is a well-balanced mix of the two.

2. In ophthalmology, I would like to continue in my research on venous blood supply to the retina and oxygen saturation. I hope to continue in this area where I had already published a number of works. I would like to integrate the clinic into an international network of centres which focus on this issue. Most of all, however, I would like the clinic to remain a valid and useful part of both institutions to which it belongs, that is, both the Military University Hospital for its clinical work and the First Faculty of Medicine of the Charles University for its academic work.

3. In both clinical work and research I focus on diseases of the retina. My particular area of interest is oxygen metabolism of the retina. Many diseases and disorders of the retina, such as diabetic retinopathy or retinal vein occlusion are caused by disorders of blood supply. These then lead to hypoxia and subsequent damage to the structures and function of the retina. For many years, we were able to measure changes to retinal oxygen saturation only by invasive methods. Now, however, we can do it by spectrophotometry, that is, without damaging the eye tissues. Different oxygen levels can tell us much about the prognosis, treatment response, or likely success of the treatment. It is a completely new approach, still so to speak ‘in its nappies’, but I think it has a great potential. It is also interesting to note that retina is the only visible part of the central nervous system so it is possible that these methods could be applied not only in ophthalmology but also in neurology.

4. That is an interesting question and I do not think I have ever paid it much thought. I must admit that given our family tradition – my father is also an ophthalmologist – I never considered another medical specialisation. I am absolutely happy with my choice. On the other hand, I believe that all areas of medicine have their beauty and one can find his or her own in each and every one. So, it does not actually matter where one decides to go after graduation. If I were to understand this question as aiming outside medicine, then I think I would like something in construction, for instance transport infrastructure.

Professor Radan Brůha, head of the 4^th Department of Internal Medicine of the First Faculty of Medicine of the Charles University and the General University Hospital

1. In a clinical department, one cannot separate these two aspects and to different degrees, they are an essential part of the work of most physicians. In contrast to clinical work, however, science can take different forms: it can mean something very different to a clinician and to a molecular biologist. In clinical medicine, research consists mostly in search for new connections and previously unknown information. It is something on top of daily specialised work, where well-tried and time-tested routines do not suffice. Nowadays, when daily medical practice involves ever more nonsensical and time-consuming administrative work, science can be an escape to a more meaningful activity. But that does not mean that science, or especially science, is not really hard work. Another part of academic life is work with students. That is often a source of inspiration and it often helps us see things in new and unexpected contexts.

2. Clinical medicine and scientific research are becoming ever more closely connected not only with each other but also with other medical fields. I cannot imagine further development without multidisciplinary cooperation. That is why one of my main goals is to involve the clinic more in interdisciplinary collaboration and make it more active in finding joint projects.

3. Scientific work is never the work of one individual. Our group focuses mainly on diseases of the liver. With a grain of salt, one could say that we focus on the most common and the least common ones. Among the most common ones are liver disorders linked to civilisation burden, that is, the fatty liver in obesity, which often leads to advanced disease of the liver and cirrhosis. Some of the rare ones are congenital metabolic liver disorders. At our clinic, we for instance follow one of the largest sets of patients with Wilson’s disease in the world, but we also do research on porphyria, and much else.

4. I do not think I would now want to do any other medical field. For one thing, I like my work, and secondly, I dedicated almost all of my professional life to acquiring necessary practice. In secondary school. I was deciding between medicine and some technical field: medicine won. But recently I am starting to ask myself one provocative question, namely whether I and my family won by this as well.

Prof. Jiří Chomiak, head of the Department of Orthopaedics of the First Faculty of Medicine of the Charles University and Na Bulovce University Hospital

1. I see the main advantages in four areas. First of all, this way we can share theoretical information as well as practical skills currently applied in clinical practice all over the world with both undergraduate students and postgraduate physicians. Secondly, it creates an opportunity of postgraduate education for clinicians in the area of experimental surgery – that is enabled by collaboration with theoretical institutes. The third advantage is in a chance of acquiring, after meeting the requisite criteria, further scientific and academic degrees and titles without the need to get teaching posts at other medical faculties. I experienced that when our department was not yet part of the First Faculty of Medicine. And fourthly, there are the opportunities created by faculty or university grant projects and plan of this department’s strategic development.

2. Our clinic is unique in focusing on all parts of orthopaedics and that is why I will try to keep on maintaining a high standard of care in all specialisations. I will also support efforts to acquire the status of centre of highly specialised care in traumatology of the musculoskeletal system and in haemophiliac care. With respect to teaching, I would like to improve the quality of education of students of both the Czech and the English programme and provide further individual education to those who are interested. In postgraduate education, I want to maintain our department’s position in the system of physicians’ education including training courses in sonography of children’s hips, treatment of clubfoot, and others. Among other things, I would like to send colleagues from the department abroad for further training courses and help international colleagues arrange training stays at our department.

In science and research, I will require that all physicians regularly publish. I will motivate them to start doctoral studies, acquire further academic titles and participate in research projects. In general, I want to build our research activities on firm foundations based on collaboration with the theoretical departments of the First Faculty of Medicine. In this way, I would like to show that orthopaedics is not based on a mere routine. New subjects worthy of scientific research are here and can shift this medical specialty further. I will also try to make sure that our department is an active member of both domestic and international scientific societies. I will make sure that the work of FIFA Medical Center of Excellence, the only centre in the Czech Republic accredited for care of footballers’ health, will continue. On top of that, we want to establish our department also as a centre of excellence in care for other sportsmen and sportswomen.

3. It is mainly the full range of paediatric orthopaedics with special focus on neuromuscular disorders. In that area, I still use knowledge acquired during my work at the Institute of Anatomy of the First Faculty of Medicine of the Charles University during my studies and then also my knowledge of neurophysiology and electromyography.

4. I would probably work at the Institute of Anatomy, where I worked during my studies and then another year after my military service in Professor Grim’s lab. Its gave me valuable foundation for further scientific work – applied research in orthopaedics.

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